| NAME: |
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| PERMANENT MAILING ADDRESS: |
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| UNIVERSITY ADDRESS: |
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| SPECIFY THE PREFERRED MAILING ADDRESS: |
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| DAYTIME TELEPHONE NUMBER WITH AREA CODE: |
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| EMAIL ADDRESS: |
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| FAX NUMBER: |
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| ARE YOU A U.S. CITIZEN? |
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| DATE OF BIRTH (MONTH/DAY/YEAR): |
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| PLACE OF BIRTH (CITY, STATE, COUNTRY): |
| CITY:
STATE:
COUNTRY:
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| HAVE YOU EVER USED OR BEEN KNOWN BY ANOTHER NAME? |
IF YES, WHAT IS THAT NAME?
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| SEX: |
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| RACE: |
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| ARE YOU CURRENTLY EMPLOYED? |
IF SO, EMPLOYER'S NAME, EMPLOYER'S ADDRESS, EMPLOYER'S TELEPHONE NUMBER, YOUR TITLE:
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| ARE YOU A REGISTERED FLORIDA VOTER? |
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| ARE YOU CURRENTLY ENROLLED AT A FLORIDA 4-YEAR COLLEGE OR UNIVERSITY? |
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| NAME OF UNIVERSITY: |
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| WHAT YEAR ARE YOU CURRENTLY IN? |
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| WHAT IS YOUR AREA OF CONCENTRATION/MAJOR? |
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| WHAT IS YOUR CUMULATIVE GRADE POINT AVERAGE? |
| GPA:
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| IF YOU ARE IN GRADUATE SCHOOL, WHAT GRADUATE BOARD EXAM DID YOU TAKE AND WHAT WAS YOUR SCORE? |
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| IF YOU ARE AN UNDERGRADUATE STUDENT, WHAT WAS YOU SAT AND/OR ACT SCORE? |
SAT:
ACT:
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| LIST ALL POST SECONDARY EDUCATION INSTITUTIONS ATTENDED (NAME AND LOCATION, DATES ATTENDED,
CERTIFICATES/DEGREES RECEIVED, ANY HONORS BESTOWED UPON GRADUATION) |
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| HIGH SCHOOL: (NAME AND LOCATION, YEAR GRADUATED) |
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| LIST ALL EXTRA CURRICULAR ACTIVITIES ASSOCIATED WITH YOUR COLLEGE, UNIVERSITY OR COMMUNITY |
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| LIST ANY HOBBIES OR SPECIAL TALENTS: |
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PLEASE LIST THE NAMES AND CONTACT INFORMATION OF THE INDIVIDUALS WHO WILL BE SUBMITTING LETTERS OF RECOMMENDATION OR PERSONAL EVALUATIONS ON YOUR BEHALF.
YOU MUST SUBMIT A MINIMUM OF THREE AND MAXIMUM OF FIVE RECOMMENDATIONS FOR CONSIDERATION.
Letters of recommendations should be mailed to Lisa Goode
no later than February 7, <%=current_year%> at:
Lisa Goode
Gubernatorial Fellows Director
Executive Office of the Governor
The Capitol, Room 705
400 South Monroe Street
Tallahassee, FL 32399
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| REFERENCE #1 |
| NAME: | |
| TITLE: | |
| RELATIONSHIP: | |
| ADDRESS: | |
| CITY: | |
| STATE: | |
| ZIP: | |
| EMAIL: | |
| PHONE: | |
| FAX: | |
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| REFERENCE #2 |
| NAME: | |
| TITLE: | |
| RELATIONSHIP: | |
| ADDRESS: | |
| CITY: | |
| STATE: | |
| ZIP: | |
| EMAIL: | |
| PHONE: | |
| FAX: | |
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| REFERENCE #3 |
| NAME: | |
| TITLE: | |
| RELATIONSHIP: | |
| ADDRESS: | |
| CITY: | |
| STATE: | |
| ZIP: | |
| EMAIL: | |
| PHONE: | |
| FAX: | |
|
| REFERENCE #4 |
| NAME: | |
| TITLE: | |
| RELATIONSHIP: | |
| ADDRESS: | |
| CITY: | |
| STATE: | |
| ZIP: | |
| EMAIL: | |
| PHONE: | |
| FAX: | |
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| REFERENCE #5 |
| NAME: | |
| TITLE: | |
| RELATIONSHIP: | |
| ADDRESS: | |
| CITY: | |
| STATE: | |
| ZIP: | |
| EMAIL: | |
| PHONE: | |
| FAX: | |
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| 4. ESSAY QUESTIONS
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| PLEASE ANSWER EACH OF THE FOLLOWING QUESTIONS IN 500 WORDS OR LESS.
YOUR RESPONSES WILL BE JUDGED ON THE CLARITY AND QUALITY OF YOUR WRITING, AS WELL AS THE SUBSTANCE OF YOUR NARRATIVES. |
| A. POLICY PROPOSAL - WRITE A MEMORANDUM FOR GOVERNOR CRIST OUTLINING A SPECIFIC POLICY PROPOSAL.
EXPLAIN WHY THIS PROPOSAL IS IMPORTANT, HOW IT WILL BENEFIT FLORIDIANS, AND WHY THE GOVERNOR SHOULD IMPLEMENT THE PROPOSAL. |
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| B. MOST SIGNIFICANT PERSONAL ACHIEVEMENT - WHAT DO YOU CONSIDER TO BE YOUR MOST SIGNIFICANT ACHIEVEMENT TO DATE AND WHY? |
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| C. WHY I WANT TO BE A GUBERNATORIAL FELLOW - DESCRIBE YOUR REASON FOR APPLYING FOR THIS PROGRAM AND WHAT BENEFITS YOU WILL BRING TO THE PROGRAM AS WELL AS GAIN FROM THIS PROGRAM. |
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| D. LIFETIME GOALS AND ASPIRATIONS - DESCRIBE YOUR LIFE'S ASPIRATIONS, WHAT YOU HOPE TO ACHIEVE, AND WHERE YOU SEE YOURSELF IN 10 YEARS FROM NOW. |
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